When choosing a nursing home, use your eyes and nose

If there are two bits of advice for choosing a nursing home that everyone agrees on, it's these:

1) Don't wait until you need one fast and have no time to be choosy.

2) Then visit the homes that are under consideration and give them a good looking over.

Having to find a nursing home fast, unfortunately, is a common situation. An older person's condition can change abruptly. He or she might be managing well alone or with help of family. But a bad fall or the onset of dementia can change everything. And it used to be that people were given time to recover in the hospital.

That's no longer true. Hospitals are now under pressure to discharge people as soon as they are medically stable, even though they might need significant nursing care and be far from able to care for themselves, or be cared for by family.

Often they are discharged to a nursing home and their families are put in the position of having to select one in a day or two.

The best nursing homes often have waiting lists. That could mean someone ends up in a poorly rated nursing home. And the family might not know the home is poorly rated until it's too late.

But people who know what they're doing can fare better. Here are some tips:

• With people living longer and hospitals discharging patients sooner, the odds are high any older person will eventually spend time in a nursing home. Don't let it be a matter of "I would never put mom in a nursing home." Talk about the potential need for a nursing home and decide what home you would prefer.
• Use Medicare Nursing Home Compare, which rates nursing homes according to a five-star scale and provides other measures of quality. It's not wise to base the decision entirely on Nursing Home Compare or any single source. But it can help weed out the bad homes and focus on the better ones. The Pennsylvania Department of Health also offers a guide. It provides basic information on all the homes in each county – things like number of beds, whether it's for-profit or nonprofit, and whether it accepts Medicaid. It also gives the status of the home's license – poor quality can lead to a provisional license – and provides links to inspection reports, which can give insights into quality of care.
• Ask friends and people at work or church about their experiences with local nursing homes, and which ones did a good job or bad job for their loved ones.
• Visit the home or homes under consideration. Virtually every expert says this is essential. Walk around the home. Is it fresh smelling or does it smell of urine. Visit during meal time. Does the food look appetizing? Do the residents seem to be enjoying their meals? Are residents who need help with eating getting it, or are they staring at their food? Watch how staff interacts with residents. Talk to the home's administrator. Ask about staffing levels. Ask about the level of staff turnover. Ask about the use of agency staff, knowing that agency staff might not be able to become familiar with your loved one, and have less of a state in providing the best possible care. Ask about activities offered to residents. Ask if the facility has a high vacancy rate. If it does, ask why. Ask if there's a waiting list. Ask if there is a volunteer program and get a description.
• Consider whether the home is for-profit or nonprofit. This is a contentious subject, with critics arguing that for-profit homes skimp on staffing to maximize profits. Some studies have found that nonprofit homes have higher staffing levels – probably the single most important factor in providing good care, safety and high quality of life for residents. But don't assume all for-profit homes are bad. If it's a nonprofit home, find out its affiliation. Nonprofit homes are often affiliated with churches or religious organizations. These are sometimes more "mission" focused, and more inclined to channeling resources toward higher staffing levels and the highest possible level of care. They also might be better positioned to obtain volunteer help, and have a charitable fund to help residents cover their costs.

It's worth knowing that the best nursing homes often have waiting lists. That means a preferred home might not have an opening when you need it. At the same time, many homes provide a continuum of care, including personal care, assisted living and home health services. People who are already associated with the home often are guaranteed a spot when they need skilled nursing.

Dr. Linda Rhodes, a former Pennsylvania Secretary of Aging, offers a useful guide. The guide provides advice on questions to ask over the phone, using Nursing Home Compare and other surveys, and what to look for when you visit the facility. It's free and can be downloaded from this link.

If you want to know more about nursing homes in central Pa., check out PennLive's list of the best and worst homes in the region. You can also use this map, created by PennLive using data from Nursing Home Compare, to quickly find the best rated nursing homes near you: (Click to Continue)

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When choosing a nursing home, use your eyes and nose